Effective Treatments for Monkeypox - 2022

             Monkeypox is no laughing matter. It can scar you for life. In complicated medical cases, this pox can be life threatening. However, to date, few if any have lost their lives in the current emerging pandemic of the less deadly West African clade of monkeypox orthopoxvirus. While those infected will have to quarantine for up to one month to prevent its spread, even if severely inconvenienced, most will merely experience a few weeks of sometimes serious pain, discomfort, and isolation.  

            The first sign of monkeypox infection is usually sores in the mouth or on the tongue, followed by flu-like symptoms. Then sores appear on the face. Next lesions may appear mostly on the hands and feet and fewer on the trunk of the body.

            The incubation period from first infection to symptoms is three to twenty-one days, but averages one week. Lesions progress through stages from macules to papules, vesicles to pustules. Finally, they crust over. Many scientists suggest that infectivity ceases once scabs fall off, replaced by new skin. Others point out that active virus remains active in the upper respiratory tract and may be contagious through kissing, coughing or close contact breathing. Researchers still do not know if testes may serve as a reservoir as they do in some other emerging viral diseases such as Ebola, or if monkeypox is potentially another sexually transmitted disease.

            Although most patients survive this self-limiting disease with no follow-on repercussions, initial dangers should not be underestimated. As with many viral infections, the underlying health condition of patients often determine the course of the disease. Those who are immune compromised, have serious comorbidities, or suffer coinfection with Covid or influenza may suffer more serious outcomes including pneumonia. Other serious potential complications include skin abscesses and life-threatening encephalitis, sepsis, or septic shock. Due to open skin lesions, approximately 19% will suffer bacterial infections requiring antibiotic treatment. Another possibility is eye infection that may cause permanent partial vision loss. Obviously, people should avoid monkeypox infection at all costs.

            The good news is that those over fifty who were vaccinated against smallpox decades ago are largely protected from monkeypox. Currently there is an effective vaccine called Jynneos. It requires two doses given four weeks apart. However, supplies are limited so injection are currently reserved for those who have been in direct contact with the disease or who are in very high-risk groups. Jynneos may help prevent symptoms if given up to four days after being infected. Administered after that, it might reduce the severity of symptoms.

            Today the only generally accepted treatment for monkeypox is the antiviral drug tecovirimat or TPOXX.

That is approved for treating smallpox. TPOXX works by inhibiting the p37 protein in the viral envelope, preventing the final formation of the viral envelope protein. TPOXX is highly effective and safe, with occasional minor side effects. It is available as an injection or pill and is taken twice a day for two weeks once symptoms develop. However currently it is reserved for the sickest patients. Although there are other vaccines and drugs mentioned as possible treatments for monkeypox, none are nearly as safe as Jynneos and tecovirimat/TPOXX.  

            Since both Jynneos and tecovirimat are currently in short supply and may require paperwork and waiting times, what other therapies should people consider who want to protect their health during this era of multi-layered pandemics?

            Besides TPOXX, safe, effective, available, affordable combination therapy exists to treat monkeypox. It can be added to TPOXX or used instead of it if it is impossible to acquire that excellent p37 inhibitor. This complementary combination therapy consists of selenium plus an NSAID drug. There are a dozen prescription and nonprescription NSAID drugs of varying strengths including aspirin, ibuprofen naproxen and diclofenac. Or choose a stronger anti-inflammatory pain killer with the advice of a physician.

            Selenium and NSAID drugs reduce viral replication and are available and affordable. Selenium is extremely safe at the doses for the few-weeks-long treatment period. Even more powerful NSAIDs are safe for most people for the time monkeypox infection lasts, up to one month. But how effective are they?  

            An effective treatment is one that shows benefit against a disease or condition. It does not necessarily cure the disease, nor does it usually prevent the disease. It merely reduces the impact of the disease by reducing either the cause or the symptoms of the disease. Selenium plus any NSAID will reduce both the cause and the symptoms of this disease because both selenium and NSAIDs work as broad-spectrum antiviral medications reducing both viral replication and inflammation. How do they do that?

            All viruses infect and reproduce inside cells Once there they commandeer the machinery of cellular protein production to replicate their own viral proteins instead of cellular ones. To do that they release the cellular jet-fuel for protein production, a replication factor called nuclear factor-kappa binding, NF-kB for sort. Releasing NF-kB supercharges both inflammation and viral production. Inhibiting NF-kB reduces viral production, slows disease progression, and reduces the intensity and symptoms of the disease including pain and inflammation. That allows the immune system to regain control. Both selenium and NSAID drugs are proven effective NF-kB inhibitors (NF-kBIs). NF-kBIs reduce the replication of all viruses that utilize NF-kB to facilitate their production. Virtually all viruses use this mechanism to reproduce themselves. Viruses also work to undermine immune defenses by depleting selenium, an element required for all aspects of immune function. And the strongest natural immune booster. Selenium supplements have proven to increase CD4 count faster than any other single medication.

            While selenium has been shown to be the strongest complementary medication for ARVs in treating HIV disease, it has also been shown to provide dramatic results in reducing the mortality rate from Marburg, Ebola, and Hantan hemorrhagic fever virus. Selenium is effective against molluscipox-virus that causes molluscum contagiosum, a close relative of monkeypox. Indeed, selenium is known to help against myriad skin conditions and somewhat reduce symptoms of depression, such as those that often accompany monkeypox and other viral infections.  

            While selenium inhibits NF-kB somewhat, adding an NSAID drug provides extra antiviral, anti-inflammatory protection. Early on in AIDS, some NSAID drugs were shown to be effective in reducing HIV viral replication, but that research was abandoned in the early 1990s in favor of protease inhibitors. Finally, NF-kBIs were resurrected in the fight against Covid-19. However instead of calling them antiviral drugs or NF-kBIs, physicians consistently referred to them as anti-inflammatories, masking their dual action. Nonetheless, the stronger an NSAID inhibits the viral jet-fuel NF-kB, the stronger it will inhibit viral replication, slow disease progression, and reduce symptomatic disease. Compared to aspirin rated as (1.0) as it inhibitory quotient some other NSAID NF-kBIs are rated as follows: ibuprofen (1.6), naproxen (6.0), diclofenac (14.9), and curcumin (131.0). A more complete list of NSAID NF-kBIs is found in the medical journal Oncogene (2004)23,9247-9258. Acetaminophen based drugs like Tylenol do not inhibit this critical replication factor, so it offers no significant activity against viruses.

            Other than perhaps an aspirin a day, NSAID drugs should not be used as prophylaxis against potential monkeypox infection. However, selenium can significantly boost the immune system in anticipation of monkeypox infection and improve overall health. Taking 200mcg of selenium daily is fully sufficient as a health precaution. However once infection occurs, the selenium dose can be increased to 400mcg to 800mcg daily, depending on the severity of the disease. This compares to the safe effective dose of 2000mcg daily used to significantly reduce the case fatality rates of Marburg, Ebola, and Hantanvirus, hemorrhagic fever virus diseases.  

            A final observation is that a topical diclofenac cream may work well to reduce pain from skin lesions. Your physician may be able to recommend a safe alternative analgesic gel for oral lesions.

            If you cannot get TPOXX treatment immediately upon infection, or even if you can, remember to apply viral first aid using selenium supplements plus NSAID NF-kB inhibitors to reduce viral replication, pain, inflammation, and other symptoms.